To safely and efficiently perform colorectal endoscopic submucosal dissection (ESD),
clear visualization of the submucosal layer is important. Therefore, various traction
methods have been developed to date [1]
[2]
[3]. However, there are few reports of using special devices other than clips, and traction
methods that are generally used have not been reported. Recently, we developed a new
clip-on-clip closure method to close the mucosal defect after ESD using clips only
[4]. Here, we describe a new traction method: clip-on-clip traction method (CCTM).
The colorectal ESD method using CCTM is shown in [Video 1]. The patient had a nongranular laterally spreading tumor, 20 mm in size, in the
rectosigmoid. Marking was done around the lesion and a full-circumference incision
was made. First, a clip was placed on the mucous membrane on the lesion side ([Fig. 1 a]). Then, a second clip was placed on the handle of the first clip ([Fig. 1 b]). Next, the teeth of a third clip were passed through the gap between the teeth
of the second clip, which served as an anchor, and then fixed to the contralateral
normal colorectal mucosa ([Fig. 1 c]). In the current case, the third clip did not fix to the contralateral colorectal
mucosa. However, there was adequate space between the teeth of the second clip for
a fourth clip to be added. This ensured a strong traction.
Video 1 Colorectal endoscopic submucosal dissection and troubleshooting using the clip-on-clip
traction method.
Fig. 1 Colorectal endoscopic submucosal dissection schema using the clip-on-clip traction
method. a After full-circumference incision of the lesion, the first clip was placed on the
mucous membrane on the lesion side. b A second clip was placed on the handle of the first clip. The gap between the teeth
of the second clip (red area) was used as an anchor. c The teeth of a third clip (green) were passed through the gap, and then fixed to
the contralateral normal mucosa.
Because the submucosa could be viewed properly using CCTM, colorectal ESD could be
performed safely without any intraoperative adverse event. As the resected lesion
was fixed with a clip to the contralateral side, the lesion could be removed from
the mucosa with a grasping forceps.
CCTM is simple, and is a novel method that can be applied safely to achieve effective
traction even in a narrow intestinal tract, such as the rectosigmoid or sigmoid colon.
Endoscopy_UCTN_Code_TTT_1AQ_2AD
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
